Objectives: Heavily treatment-experienced (HTE) people living with HIV (PLWH) pose unique challenges due to limited antiretroviral treatment (ART) options. Our study aimed to investigate the prevalence and features of HTE individuals followed up in the Italian Cohort Na & iuml;ve Antiretrovirals (ICONA) cohort as of December 31, 2021. Methods: HTE were defined based on meeting specific conditions concerning their current ART and their ART history up to December 31, 2021. Descriptive statistics were performed by HTE status. Regression analyses explored factors associated with becoming HTE based on pre-ART patients' characteristics. Cluster dendrogram analysis provided insights into subgroups with inadequate responses based on clusters of differentiation (CD4) counts and viral load (VL) trajectories. Results: Among the 8758 PLWH actively followed in our cohort, 163 individuals (1.9%), mainly female, younger, Italian, and infected through heterosexual contact, met the HTE criteria. A lower CD4 count at ART initiation (odds ratio [OR] 1.60 per 100 cells/mmc lower CD4, 95% confidence interval [CI] 1.06-2.41, P = 0.03) and hepatitis C virus antibody positivity (OR 1.90, 95% CI 1.16-3.11, P = 0.01) were associated with higher HTE risk. Thirty PLWH exhibited ongoing immune-virological failure (18% of the HTE subgroup and 0.003% of the total population). Thirty PLWH exhibited ongoing immune-virological failure (i.e., with a current CD4 count < 200 cells/mmc or VL > 200 copies/mL). A cluster analysis identified 13 (43%) with a current CD4 count < 200 cells/mmc. Also, notably, 19/30 (63%) had major acquired resistanceassociated mutations to at least one antiretroviral drug class. Conclusions: HTE is rare in our cohort and tends to co-exist with major resistance mutations. A focused investigation into treatment history and immuno-virological response is warranted, particularly given the availability of new antiretroviral drugs.

Lo Caputo, S., Poliseno, M., Tavelli, A., Gagliardini, R., Rusconi, S., Lapadula, G., et al. (2024). Heavily treatment-experienced persons living with HIV currently in care in Italy: characteristics, risk factors, and therapeutic options-the ICONA Foundation cohort study. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, 143, 1-8 [10.1016/j.ijid.2024.01.023].

Heavily treatment-experienced persons living with HIV currently in care in Italy: characteristics, risk factors, and therapeutic options-the ICONA Foundation cohort study

Sarmati, Loredana;Ceccherini-Silberstein, Francesca;Cozzi-Lepri, Alessandro
2024-06-01

Abstract

Objectives: Heavily treatment-experienced (HTE) people living with HIV (PLWH) pose unique challenges due to limited antiretroviral treatment (ART) options. Our study aimed to investigate the prevalence and features of HTE individuals followed up in the Italian Cohort Na & iuml;ve Antiretrovirals (ICONA) cohort as of December 31, 2021. Methods: HTE were defined based on meeting specific conditions concerning their current ART and their ART history up to December 31, 2021. Descriptive statistics were performed by HTE status. Regression analyses explored factors associated with becoming HTE based on pre-ART patients' characteristics. Cluster dendrogram analysis provided insights into subgroups with inadequate responses based on clusters of differentiation (CD4) counts and viral load (VL) trajectories. Results: Among the 8758 PLWH actively followed in our cohort, 163 individuals (1.9%), mainly female, younger, Italian, and infected through heterosexual contact, met the HTE criteria. A lower CD4 count at ART initiation (odds ratio [OR] 1.60 per 100 cells/mmc lower CD4, 95% confidence interval [CI] 1.06-2.41, P = 0.03) and hepatitis C virus antibody positivity (OR 1.90, 95% CI 1.16-3.11, P = 0.01) were associated with higher HTE risk. Thirty PLWH exhibited ongoing immune-virological failure (18% of the HTE subgroup and 0.003% of the total population). Thirty PLWH exhibited ongoing immune-virological failure (i.e., with a current CD4 count < 200 cells/mmc or VL > 200 copies/mL). A cluster analysis identified 13 (43%) with a current CD4 count < 200 cells/mmc. Also, notably, 19/30 (63%) had major acquired resistanceassociated mutations to at least one antiretroviral drug class. Conclusions: HTE is rare in our cohort and tends to co-exist with major resistance mutations. A focused investigation into treatment history and immuno-virological response is warranted, particularly given the availability of new antiretroviral drugs.
giu-2024
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/07
English
Antiretroviral treatment
HIV
Heavily treatment-experienced
Immune-virological failure
Resistance mutations
Lo Caputo, S., Poliseno, M., Tavelli, A., Gagliardini, R., Rusconi, S., Lapadula, G., et al. (2024). Heavily treatment-experienced persons living with HIV currently in care in Italy: characteristics, risk factors, and therapeutic options-the ICONA Foundation cohort study. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, 143, 1-8 [10.1016/j.ijid.2024.01.023].
Lo Caputo, S; Poliseno, M; Tavelli, A; Gagliardini, R; Rusconi, S; Lapadula, G; Antinori, A; Francisci, D; Sarmati, L; Gori, A; Spagnuolo, V; Ceccheri...espandi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/382785
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